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Alpha-1 antitrypsin (AAT) deficiency is an under-diagnosed disease and screening programs have therefore been recommended for patients with chronic obstructive pulmonary disease (COPD). We present the results of the pilot phase of a screening program for AAT deficiency in order to evaluate the technique used, the procedures for transporting samples and the results obtained. Over a period of one month, five centers collected samples from all COPD patients for whom plasma concentrations of AAT or Pi phenotype had not yet been determined. Capillary blood spots were dried on filter paper and then sent by surface mail to a central laboratory for study. An immunonephelometric assay was used to determine AAT and DNA phenotyping was done by use of a Light Cycler. Samples were analyzed from 86 COPD patients (76 men, 10 women) with a mean age of 68.2 years. AAT deficiency was ruled out for 74 patients (86%) who had concentrations above the cutoff established, although one of them was MZ heterozygote by genotype. Among the 12 remaining patients (13.9%), only two also had a Z allele. The rest were individuals with concentrations below the established threshold and no evidence of a Z allele (10 patients, 11.6%). The Z allele frequency observed (3/172; 1.74%) was very similar to that found in the general population. The results of this pilot study allowed us to confirm that the method used to collect samples worked well. The sampling method is applicable, easy and well-accepted by participating physicians. It allowed AAT concentrations and Z allele deficiency to be determined. The method correlates well with standard techniques used for samples in whole blood.

Introduction: Small cell lung cancer (SCLC) comprises 10-15% of all lung cancer cases and is the most aggressive histological type. Survival is poor and the molecular landscape of this disease is extraordinarily complex. The objective of this paper was to perform a Genome-Wide Association Study (GWAS) of this disease using a case-control study specifically designed for small cell lung cancer (SCLC)., Methods: Incident cases were consecutively recruited from 8 hospitals from different regions of Spain. Controls were recruited from the same hospitals using a frequency sampling based on age and sex distribution of cases. Biological samples were obtained along with detailed information on cases and controls lifestyle, including tobacco and radon exposure., Results: We included 271 SCLC cases and 557 controls. We found evidence (p-values<10 -5 ) of an association in the complete dataset for several loci, while MAP4 showed a significant association in the gene-based analysis. Pathway analysis suggested that ATR, ATRIP, MCM4, MCM5, ORC4, RPA3 and CDC25A genes have a role on the onset of SCLC., Conclusion: This study provides biological evidence for pathways related to SCLC, offering novel loci for further research., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

The respiratory syncytial virus (RSV) causes a substantial burden worldwide. After over six decades of research, there is finally a licensed immunization option that can protect the broad infant population, and other will follow soon. RSV immunization should be in place from season 2023/2024 onwards. Doing so requires thoughtful but swift steps. This paper reflects the view of four immunization experts on the efforts being made across the globe to accommodate the new immunization options and provides recommendations organized around five priorities: (I) documenting the burden of RSV in specific populations; (II) expanding RSV diagnostic capacity in clinical practice; (III) strengthening RSV surveillance; (IV) planning for the new preventive options; (V) achieving immunization targets. Overall, Spain has been a notable example of converting RSV prevention into a national desideratum and has pioneered the inclusion of RSV in some of the regional immunization calendars for infants facing their first RSV season., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)

Chronic obstructive pulmonary disease (COPD) is a public health problem due to its high prevalence (11% in the adult population in Spain), increasing incidence, and great social and economic impact. Despite this, it is underdiagnosed (and, therefore, undertreated) at a rate of around 80%. In this paper, a group of respiratory physicians specializing in COPD discuss 7 fundamental problems ("cardinal sins") that contribute to this situation, with the explicit aim of proposing specific solutions that may help to improve this unfavorable state of affairs., (Copyright © 2022 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries., Methodology: Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction., Results: 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P<.05)., Conclusions: A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: The distribution of chronic obstructive pulmonary disease (COPD) in women, and its underdiagnosis and determinants in the general population, have not been well described. The EPI-SCAN study is an epidemiologic, observational study conducted at 11 Spanish centers on the general population aged 40 to 80., Patients and Method: This paper describes the rates and extrapolates the population burden from the 3,802 participants of the EPI-SCAN study., Results: With 2,005 female and 1,797 male participants, there was a lower prevalence of COPD in women (5.7%; 95%CI, 4.7-6.7) than in men (15.1%; 95%CI, 13.5-16.8; P<.05). Among the 386 participants with COPD, 114 (29.5%) were women, who were younger, currently smoked less and had lower tobacco smoke exposure, while reporting a lower level of education (P<.05). As for the respiratory symptoms, there were no differences between sexes for cough, dyspnea or wheezing, but the women with COPD reported sputum less frequently (P<.05). There were no differences in the spirometric severity of COPD between women and men. Overall, 73% of the patients with a spirometric COPD criteria were underdiagnosed, and this percentage is unevenly distributed by sex, being 1.27 times more frequent in women (86.0%) than in men (67.6%) (P<.05). By extrapolating the rates of prevalence and underdiagnosis of COPD to the general population, we estimate that there are 628,102 Spanish women between the ages of 40 and 80 with COPD, 540,168 of whom still have not been diagnosed., Conclusions: There is a greater underdiagnosis of COPD in women than in men in Spain., (Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.)

Introduction: This present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort., Patients and Methods: CHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background: Occupational asthma (OA) is the most common work-related disease in industrialized countries. In 2008, only 556 cases of OA had been diagnosed in Spain, which is quite far from even the most conservative estimates. In this context, the aim of this paper is to estimate the number of asthma cases attributable to the work setting in Spain in 2008 as well as the related health care costs for the same year., Methods: The number of cases of OA was calculated from estimates of attributable risk given by previous studies. The cost estimation focused on direct health-care costs and it was based both on data from the National Health System's (NHS) analytical accounting and from secondary sources., Results: The number of prevalent cases of work-related asthma in Spain during 2008 ranges between 168 713 and 204 705 cases based on symptomatic diagnosis, entailing an associated cost from 318.1 to 355.8 million Euros. These figures fall to a range between 82 635 and 100 264 cases when bronchial hyperreactivity is included as a diagnostic criterion, at a cost of 155.8-174.3 million Euros. Slightly more than 18 million Euros represent the health-care costs of those cases requiring specialized care., Conclusions: Estimations of OA are very relevant to adequately prevent this disease. The treatment of OA, which involves a significant cost, is being financed by the NHS, although it should be covered by Social Security., (Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.)

The evaluation of the disabilities of patients with respiratory disease is regulated by the Spanish Ministry of Labor and Social Security, as are disabilities of any other type. We believe, however, that in respiratory pathologies this evaluation is especially complicated because, as they are chronic processes, they inter-relate with other systems. Furthermore, they tend to have occasional exacerbations; therefore, normal periods may alternate with other periods of important functional limitations. The present document arises from the desire of SEPAR to update this topic and to respond to the requests of respiratory disease patient associations who have asked us to do so. In this paper, we analyze the current situation of work disability legislation as well as the determination of degrees and percentages, including the current criteria for assigning disabilities due to respiratory tract deficiencies. Lastly, we propose work guidelines that would improve the existing scenario and outline this evaluation for specific pathologies., (Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.)

The introduction of highly active antiretroviral therapy (HAART) has resulted in a reduction of opportunistic infections associated with cellular and humoral immunosuppression. However, what is still unclear is the impact of HAART on the development of other diseases not associated with AIDS, such as lung cancer and COPD. The aim of this paper is to review the most innovative and relevant aspects of lung pathology in patients infected with HIV., (Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.)

This present paper describes the general characteristics, objectives and organizational aspects of the respiratory disease registries in Spain with the aim to report their activities and increase their diffusion. The document compiles information on the following registries: the Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency, Spanish Registry of Bronchiectasis, International Registry of Thromboembolic Disease, Spanish Registry of Occupational Diseases, Spanish Registry of Pulmonary Artery Hypertension, Registry of Pleural Mesothelioma, Spanish Registry of Tuberculosis and Spanish Multi-center Study of Neuroendocrine Pulmonary Tumors. Our paper provides information on each of the registries cited. Each registry has compiled specific clinical information providing data in real situations, and completes the results obtained from clinical assays. Said information has been published both in national as well as international publications and has lead to the creation of various guidelines. Therefore, the activities of the professionals involved in the registries have spread the knowledge about the diseases studied, promoting the exchange of information among workgroups., (Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved.)

Objective: The aim of this study was to compare the production, impact and co-authorship of publications by Spanish authors on smoking and tobacco between two time periods (1998/2002 vs 2003/2007) using Science Citation Index (SCI)., Methods: The literature search was performed in the SCI-Expanded on 20 November 2008. All types of documents by Spanish authors were selected. The search was restricted to the title, and the key words used were "smok*" and "tobac*". The statistical analysis was descriptive (95% CI)., Results: A total of 588 documents were obtained, with 399 (67.85%) original papers, 54 (9.18%) letters to the editor, and 35 (5.95%) editorials. Productivity increased between the 98/02 to 03/07 periods: 234 (39.8%) documents versus 354 (60.2%). We have found significant differences between the two periods (98/02 vs 03/07) in total mean annual documents (47 ± 8 vs 71 ± 16 [p=0.024]) and total mean annual original papers (34 ± 6 vs 46 ± 9 [p=0.041]). The mean number of citations per document was 14.1 ± 2.1 for 98/02 period and 5.6 ± 2.5 for 03/07 period (p=0.003). The co-authorship annual index had increased; with a mean of 6.77 signatures/document for 98/02 period to a mean of 6.87 for 03/07 period. Authors and institution networks collaborations had increased between the two periods., Conclusions: Spanish production and co-authorship of documents on smoking and tobacco have increased between these two periods. The earlier period documents received more citations., (Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved.)

Decision-making in COPD is complicated by the lack of clear prognostic factors. In this clinical situation it is also necessary to include the desires, values and choices of patients. The problem is more complex in the critical episodes, where the patients are incapable to make decisions. The instruments that allow incapable patients to represent themselves, the kind of patients who could benefit from its use, and the Spanish legislation on the matter, are presented in the first part of the work. The paper goes on to explain how to apply advance directives to the case of COPD. The article concludes that the appropriate use of advance directives and advanced care planning increases the quality of decisions at the end of the life of the patients with COPD.", (2009 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Scientific cooperation is essential for the advance of biomedical research. Scientists set up informal groups to work together on common issues, who are the main units in the research funding system. Bibliometric and Social Network Analysis methods allow informal groups in scientific papers to be identified and characterised. The objective of the study is to identify research groups in Archivos de Bronconeumología between 2003 and 2007 period with the aim of characterizing their scientific collaboration patterns and research areas., Methods: Co-authorships, institutional collaboration relationships and the main research areas of papers published in Archivos de Bronconeumología have been identified. Co-authorship networks and institutional collaboration networks have been constructed by using Pajek software tool., Results: A total of 41 research groups involving 171 investigators have been identified. The Collaboration Index for articles was 5.59 and the Transcience Index was 73.11%. There was institutional collaboration in 60.33% of papers. The collaboration between institutions of the same region prevails (41.03%), followed by collaborations between departments, services or units of the same institution (39.74%), inter-regional collaboration (14,97%) and international collaboration (6.83%). A total of 83.03% of articles were cited. The main research areas covered by groups were chronic obstructive pulmonary disease, asthma, lung neoplasm, bronchogenic carcinoma, smoking and pulmonary embolism., Conclusions: The scientific production of a large number of Respiratory System Spanish research groups is published in Archivos de Bronconeumología. A notable collaboration and citation rate has been observed. Nevertheless, it is still essential to encourage inter-regional and international collaboration., (Copyright 2009 SEPAR. Published by Elsevier Espana. All rights reserved.)

Objective: To analyze Spanish scientific research output related to tuberculosis during the 10-year period from 1997 through 2006 and to consider it within the context of European Union (EU) productivity., Material and Methods: The bibliometric study was based on a search of the MEDLINE database, using the PubMed search interface. Search terms were tuberculosis or tuberculous appearing in any database field., Results: Of 35 735 titles retrieved, 1191 were by Spanish authors. This represented 4.1% of world output. Spain, accounting for 13.5% of EU scientific output in this area, was the third most productive EU country; 610 (51.2%) of the papers were published in English and 581 (48.8%) in Spanish. The number of papers published remained steady over the 10-year period. The first author's specialty was usually microbiology (225 documents, or 20.6%), followed by internal medicine (154, or 14.1%), and respiratory medicine (117, 10.7%). Journals publishing the largest numbers of papers on tuberculosis were Medicina Clínica and Enfermedades Infecciosas y Microbiología Clínica with 78 (6.5%) each, Anales de Medicina Interna with 72, Revista Clínica Española with 64, and Archivos de Bronconeumología with 63. The most productive provinces were Madrid and Barcelona, with 272 (22.8%) and 256 (21.5%) papers, respectively. The most productive institutions were hospitals, with 900 titles (75.6%), followed by universities, with 132 (11.1%)., Conclusions: Tuberculosis research in Spain has taken place at a steady rate over the last 10 years and has accounted for a substantial proportion of EU research in this field. Half the papers by Spanish authors were found in international journals published outside Spain. The majority of papers were from authors working in hospitals.

The sinking of the oil tanker Prestige off the coast of Galicia was not only the worst ecological disaster ever to affect Spain, it also led to thousands of people who participated in the cleanup of the contaminated areas being exposed to potentially dangerous toxic substances. As the airway is one of the principal routes of entry into the body of these toxic compounds, the possible effects of exposure to such spills is of particular interest and concern to respiratory specialists. The paucity of clinical information available on the subject was the motive for this paper, which reviews the scientific studies undertaken in the aftermath of other accidents involving oil tankers and concludes with a summary of the clinical and epidemiological data published to date on the Prestige oil spill.

Objective: To analyze the network structure of collaboration between medical centers sharing authorship of scientific articles on smoking., Material and Methods: Articles reporting smoking research by authors from 2 or more Spanish medical centers between 1999 and the end of 2003 were identified through the Science Citation Index. The network of collaboration behind the research was analyzed and the most important measures of centrality were compared. To display the data, scientometric maps were constructed using UCINET and NETDRAW network analysis tools., Results: Thirty-five Spanish medical centers (29 hospitals and 6 health care clinics) in 8 autonomous communities were involved in 21 collaborative research projects. Hospital de La Princesa was the network core institution with the highest degrees of nodal (16), closeness (88.66), and betweenness (39) centrality. Other core nodes in the network were the following hospitals: de Cruces, San Pedro de Alcántara, La Paz, Vall d'Hebron, and General Yagüe. The autonomous communities of Castile and Leon, Madrid, and Catalonia were assigned positions at the core of the intercommunity collaborative network based on coauthorship of scientific papers shared among their medical centers., Conclusions: Network analysis helps identify the most influential institutions in a scientific community that generates coauthored articles in the field of smoking research. Hospital de la Princesa had the highest measures of centrality. The autonomous communities of Castile and Leon, Madrid, and Catalonia form a highly connected, cohesive subgroup within the network.

Clinical research plays an increasingly strong role in the development of respiratory medicine. Familiarity with issues that affect research on human subjects is therefore essential, particularly so with regard to the conduct of clinical trials of medical with medications. This paper begins with a brief introduction to the ethics of clinical research. We highlight the importance of directives on ethics and the need to understand and comply with them when any type of experiment is conducted on humans. Following is a brief description of historical codes of bioethics and an account of their underlying principles, origins, and consequences. Finally, we discuss Spanish Royal Decree 23/2004 of February 6, 2004 which came into force on May 1 that year; we outline its general principles and analyze 2 types of problem that have emerged: those that result from the article requiring a single central opinion and those of investigators who act independently of the pharmaceuticals industry. The situation of clinical research in respiratory medicine at our hospital is then described. Finally, the 7 requirements of ethical research listed by Emanuel and colleagues are proposed as a tool that pneumologists can use to analyze and assess whether or not a specific trial meets minimum ethical requirements.

Background: This paper reports the findings of a prospective multicenter study whose main objective was to determine the indications for video-assisted thoracoscopic surgery (VATS), as well as the techniques used, results and complications., Methods: Seventeen chest surgery units provided data on 1,573 procedures performed over a period of two years (July 1996 to July 1998)., Results: Spontaneous pneumothorax (45.4%), lung biopsy (18.4%), pulmonary nodes (13.3%) and thoracic sympathectomy (5.3%) accounted for over 80% of the indications for VATS. An assistive mini-thoracotomy was required in 5.6%. A change to standard thoracotomy was needed in 167 cases (10.6%). Complications were observed in 10.8%, persistent air leakage being the most important. Spontaneous pneumo-thorax recurred in 17 cases (2.4%). Ten patients (0.6%) died., Conclusions: Technological developments have led to new applications for VATS as well as improved outcome for the most common, well established indications. It is advisable to continue to perform prospective, randomized, controlled trials to validate techniques for which little experience has accumulated.

Preliminary results from the Spanish cooperative group for the treatment of palmar hyperhidrosis by video-assisted thoracoscopic surgery are presented in this paper. We have reviewed the cases of all patients with this disease treated by the group, especially noting the technique, the early results and complications. Video-assisted thoracoscopy emerges as the treatment of choice, given the ease with which the thoracic sympathetic chain can be resected, its safety, the lack of observed complications, and the good short-term results.

This paper analyzes the influence of perioperative transfusion on survival after lung cancer surgery. Between January 1991 and December 1995, we enrolled 405 patients, 196 of whom received transfusions and 209 of whom did not. Follow-up extended to December 1997. Excluded were patients undergoing exploratory thoracotomy (n = 92), those who died during the postoperative period (n = 19) and those lost to follow-up (n = 13). The final number of patients in the study was 281 (136 who received transfusions and 145 who did not). We analyzed age, sex, general clinical status measured on the Eastern Cooperative Oncology Group (ECOG) scale, histological type and TNM staging. Single and multiple variable analyses were performed. At the end of the study 158 patients were alive and 123 had died. Transfusions were used more often in pneumonectomies (p < 0.001) and in patients with an ECOG score of 2 (p < 0.01). Survival at 36 and 60 months, calculated using the Kaplan-Meier method was 52% and 30%, respectively, for those who had received transfusions, and 53% and 49%, respectively, for those who had not. The differences were not statistically significant (p > 0.1). Multivariant analysis failed to demonstrate an influence of transfusion on survival (relative risk of 1.08; 95% confidence interval 0.72-1.61; p > 0.1). We conclude that there is no negative prognostic effect of perioperative transfusion.

Objectives: To assess the implantation and quality of written IC in the pulmonology units of Spanish hospitals., Method: A descriptive study was initiated with a nation-wide mail and/or telephone survey of 117 Spanish hospitals to determine whether or not written ICs were signed before fiberoptic bronchoscopy. If the respondents answered affirmatively, a copy of the form was requested for evaluation. Evaluation criteria were a) whether IC was specific for fiberoptic bronchoscopy, and if it was, b) whether it contained information as well as a declaration of consent, and c) whether the information and declaration were adequate, fulfilling minimum requirements., Results: Seventy-three pulmonology units (60%) responded and 49 of them (67.1%) reported that they obtained written ICs while 24 (32.9%) did not. Of the 49 departments that reported asking for written IC, 41 (83%) used forms that were specific for fiberoptic bronchoscopy and 8 (17%) used nonspecific forms. The 41 units with specific IC forms submitted papers containing both information and declaration sections. The information was adequate in 10 cases (24%) and the declaration was appropriate in 17 (41%); only 6 (14%) had both adequate information and an appropriate declaration., Conclusions: Written ICs are increasingly common and are present in 67% of the pulmonology units that responded to the questionnaire. The low number of forms meeting minimum requirements is remarkable. It would be useful to design an IC form that respects our specific sociocultural context for use nation-wide in Spain.

This paper reports the prevalence of smoking among adolescent students in Navarra, analyzing the data by sex and geographic area. A sample representative of Navarran adolescent school children between 12 and 18 years old was identified. The prevalence of smoking was measured by way of an anonymous self-administered questionnaire filled out at school. A chi 2 test and analysis of variance were performed. Three hundred students (180 girls, 51.43%; 170 boys, 48.57%) were surveyed. Mean ages were 14.35 +/- 1.82 and 14.15 +/- 1.93 years, respectively. Smoking prevalence was 35% among girls in the Foral Community of Navarra and 28.82% among the boys. The age of initiation to smoking and frequency of smoking are analyzed for the five geographic areas of the Navarra province. The prevalence of smoking is higher among girls. Children are tending to start smoking at earlier ages (primary school). No differences in smoking frequency were observed for rural and urban areas.

This paper describes the translation to Castilian and adaptation of a quality of life measurement instrument: the Asthma Quality of Life Questionnaire (AQLQ). The AQLQ, developed by Juniper et al, contains 32 items, 5 of which relate to habitual activities that the patient can choose from among a list of 26 possibilities. Answers are given on a scale of 7 points. To adapt this instrument for use in Spain, we subjected it to a process of translation/back translation by bilingual informants. The translated and original versions of each item, activity and answer option were evaluated as being totally equivalent (A), fairly equivalent but with some questionable wording (B), or of questionable equivalence (C). The naturalness and correctness of the Spanish version were also evaluated on a scale of 1 to 10. Three (9%) items and 1 (4%) activity were considered to be of questionable equivalence (C) and 12 (37%) items and 1 activity (4%) were considered to be of type B equivalence. The questionable aspects of types B and C equivalence were discussed in 2 meetings, along with expressions that were equivalent but unnatural or grammatically incorrect; the first meeting involved researchers and translators and the second was held with a group of 6 asthmatics. Consensus was finally obtained for each item and activity included in the second draft. That draft was then administered to another group of 7 patients in order to check comprehension and equivalence, after which a definitive version was produced by the researchers.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper is a report of a cross-sectional epidemiological study that formed part of multicenter European project; the aim was to estimate the prevalence of respiratory symptoms and signs related to asthma over a period of 12 months in the city of Seville. A sample of 4,000 persons of both sexes, aged between 20 and 44 years old, was surveyed first by mail questionnaire and later by telephone interview. We analyzed the response index obtained with the mail survey for the epidemiological study of asthma in the area and for the frequency of respiratory symptoms and their distribution by age and sex. The response index was 53.36% and was similar for men and for women. Forty-nine percent reported at least one respiratory symptom, with nocturnal coughing attacks (27.7%) and wheezing (22.2%) being the most frequent. The frequency of these symptoms was different by sex, however, with the former more often reported by women (p < 0.02) and the latter by men (p < 0.001). We found that 14.9% of the population had rhinitis and that women reported this symptom more often (p < 0.02). Symptoms related to asthma were nocturnal attacks of breathlessness, the use of asthma medication and an asthma attack diagnosed by a physician within the last 12 months. With these criteria the estimated prevalence of asthma was 11.72%, a proportion that held steady for all age groups except the middle-aged and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)